Appropriateness of the treatment of fatigued patients with stage IV cancer

Fatigue among patients with cancer is prevalent, disabling, and treatable. While fatigue management guidelines have been in place for a decade, their use remains unclear. We surveyed 160 patients with stage IV lung (40), breast (40), colon (40), and prostate (40) cancer who reported moderate to severe fatigue (i.e., > 5 of 10 on an 11-point numerical rating scale). Participants were queried about receipt of treatments in fatigue management domains emphasized in the National Comprehensive Cancer Network guidelines: general management strategies, activity enhancement, psychosocial strategies, and pharmaceuticals. The cohort was half male, had a mean age of 67, and reported an average fatigue rating of 6.4. Participants reported treatment or receipt of specific guidance in the fatigue management domains as follows: general management strategies 16.8 %, activity enhancement 11.9 %, psychosocial strategies 9.9 %, and pharmaceuticals 37.3 %. Fatigue > 7 of 10 increased the likelihood of instruction in activity enhancement but no other domain. The low rates of guideline-congruent treatment reported here are concerning, particularly as better validated behavioral treatments were the least prescribed.